Internet-based healthcare services use patterns and barriers among middle-aged and older adults in China: a cross-sectional study

Abstract

Background: The global aging trend has intensified chronic disease burdens, widened healthcare access disparities, and exacerbated unmet care needs. Internet‑based Healthcare Services (IHS) present a promising strategy to address these challenges. This study investigates the prevalence and determinants of IHS use, as well as the primary motivations and barriers to adoption among adults aged 50 years and older in mainland China.

Methods: An online cross-sectional survey was conducted in March 2021 among adults aged 50 years and older in mainland China. Participants (N = 560) were recruited through random sampling on an online platform. Logistic regression models were used to identify predisposing, need, and enabling factors associated with IHS use.

Results: Only 17.14% of respondents reported using IHS, with online medical consultation being the most common (38.5%). Respondents aged between 50 and 59 years (AOR = 4,975 [95% CI 1.224-19.608]), urban residents (AOR = 6.056 [95% CI 1.689-21.713]), higher income (AOR = 3.862 [95% CI 1.822-8.186]), chronic conditions (AOR = 5.567 [95% CI 2.167-14.301]), delays in seeking healthcare (AOR = 5.323 [95% CI 2.866-9.888]), mobility difficulties (AOR = 9.802 [95% CI 4.005-23.993]), positive attitude (AOR = 3.038 [95% CI 1.039-8.884]) were more likely to use IHS, after adjusting for other variables. The main barriers to IHS use included distrust and uncertainty about describing symptoms online.

Conclusion: Low levels of IHS use were observed among middle-aged and elderly populations in mainland China. Although IHS can benefit individuals with high healthcare needs or mobility limitations, income-related and urban-rural inequalities in IHS use persist. Addressing trust issues and enhancing digital literacy among the elderly are essential for the widespread and effective development of IHS.

Keywords: Aging Populations; China; Chronic Diseases; Digital Health Adoption; Digital Health Equity; Digital Literacy; Healthcare Utilization; Internet Medical Services; Middle-Aged and Older Adults; Telemedicine.